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The Israel National Cancer Registry
Barbara G. Silverman, MD, MPH
Director, Israel National Cancer Registry
Israel Center for Disease Control
Israel Ministry of Health
January 2015
INCR –the numbers
Population-based, passive registry covering the entire Israeli
population (≈8 million)
Founded in 1960; mandatory reporting beginning in 1982
Currently includes data on over 700,000 cases in approximately
650,000 Israelis
Approximately 30,000 new cases added per year
Data complete through 2012
Reporting to the INCR is mandatory for:
All in situ and malignant neoplasms (including hematologic
malignancies) with the exception of:
Basal cell carcinoma
Squamous cell carcinoma of the skin (excluding SCC of the skin
of the genitals, which must be reported)
All neoplasms of uncertain behavior
Benign neoplasms of the brain and central nervous system
“Suspected” diagnoses based on clinical criteria (rather than
pathology results) must be reported
The requirement for reporting applies to:
Public and private pathology, cytology and hematology
laboratories
Hospitals
Oncology centers
Local health districts (death certificates)
Health funds
Reporting methods:
Regular mail
Secure server
Patient listings by electronic mail
National Bureau of Statistics
Oncology/hematology clinics
(13) Hospital medical records
departments
(29)
Hospital and community
pathology laboratories
(30)
ISRAEL NATIONAL CANCER
REGISTRY
Local health bureaus (death
certificates)
Reporting to the INCR, 2014
Regular
mail Secure
server Electronic
mail Pathology 39,508 30,156 69,664 Discharge summaries 35,347 13,894 9 49,250 Oncology centers 1,735 1,146 15,268 18,149 Death certificates 6,137 404 6,541 Hematology centers 757 757
Total 83,484 45,196 15,681 144,361
Pathology reports
Oncology programs
Medical records
Death certificates/CBS
Site and histology
Tumor size/Lymph
node
involvement/extent
of spread
Surgeries
Site and histology
Stage
Treatment
Demographic data
Vital status
Malignancy as cause of
death
Site and histology
Stage
Treatment
Surgical procedures
International Classification of Diseases
for Oncology (ICD-O-3)
Topography code—anatomic site
Morphology code—histologic diagnosis
Fifth digit of histology code represents
tumor behavior (benign, uncertain, in
situ, malignant)
ICD-O-3 topography (site) codes
ICD-O-3 morphology codes
Cancer coding
Diagnosis ICD-9 ICD-10 ICD-O-3
Topography Morphology
Adenocarcinoma metatastatic to
lung, unknown primary
199.1 C80.0 C80.9 8140/3
Adenocarcinoma, lung 162.9 C34.9 C34.9 8140/3
Squamous cell carcinoma, lung 162.9 C34.9 C34.9 8070/3
Carcinoma (NOS) of breast,
metastatic to lung
174.9 C78.0 C50.9 8010/3
Middle East Cancer Consortium (MECC)/SEER classification:
Staging
Stage Description
0 In situ in situ/
localized 1 Localized
2 Regional, direct extension
Regional spread 3 Regional, lymph nodes
4 Regional, direct extension & lymph nodes
5 Regional, NOS
7 Distant Distant spread
9 Undetermined
SEER summary staging-lung cancer
-400 -300 -200 -100 0 100 200 300 400
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+
Population in thousands
age
gro
up
s
males females
150 100 50 0 50 100 150
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90-94
95+
Population in thousands
age
gro
up
s
males females
Age distribution of the Israeli population, 2012
Jewish Arab
Most common cancers, by gender and
population group, Israel 2012
Males Females
Jewish Arab Jewish Arab
Site % of
cases
Site % of
cases
Site % of
cases
Site % of
cases
Prostate 20.9 Lung 19.7 Breast 32.9 Breast 33.1
Colon/rectum 13.2 Prostate 12.5 Colon/rectum 10.8 Colon/rectum 10.7
Lung 11.0 Colon/rectum 12.0 Lung 6.5 Thyroid 7.6
Bladder 6.4 Bladder 5.5 Uterus 5.7 Non-Hodgkin
lymphoma
5.5
Non-Hodgkin
lymphoma
5.7 Non-Hodgkin
lymphoma
5.4 Thyroid 5.4 Uterus 5.3
Most common causes of cancer deaths, by
gender and population group, Israel, 2012
Males Females
Jewish Arab Jewish Arab
Site % of
cases
Site % of
cases
Site % of
cases
Site % of
cases
Lung 19.9 Lung 34.3 Breast 19.1 Breast 18.7
Colon/rectum 13.2 Colon/rectum 9.3 Colon/rectum 12.9 Colon/rectum 11.8
Pancreas 9.1 Pancreas 6.3 Lung 11.4 Lung 8.0
Prostate 8.1 Stomach 5.6 Pancreas 7.7 Leukemia 7.7
Non-Hodgkin
lymphoma
5.8 Leukemia 5.4 Ovary 5.8 Stomach 6.3
Lung cancer in Israel ICD-O-3 site codes C34.* (excluding lymphomas and
mesothelioma)
Classification of histology
Squamous cell carcinoma (ICD-O-3 histology codes 8050-8078, 8083-8084)
Adenocarcinoma (ICD-O-3 histology codes 8140, 8211, 8230-8231, 8250-8260, 8323, 8480-8490, 8550-8551, 8570-8574, 8576)
Small cell carcinoma (ICD-O-3 histology codes 8041-8045, 8246)
Large cell carcinoma (ICD-O-3 histology codes 8010-8012, 8014-8031,8035,8310)
All other histology codes
Age-standardized rates (ASR), lung cancer, Israel
1980-2012
0
10
20
30
40
50
60
Jewish males Jewish females Arab males Arab females
Lung cancer, by histologic group, Israel
1960-2012
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
SCC AdenoCA small cell large cell other
Crude lung cancer incidence, by age group,
gender, and population group, 1960-2012
0
20
40
60
80
100
120
140
160
180
200
לור
יעש
-10
0,00
0
+45בגילאים , נשים ערביות +45בגילאים , גברים ערבים +45בגיאלים , נשים יהודיות +45בגילאים , גברים יהודים 45נשים ערביות מתחת לגיל 45גברים ערבים מתחת לגיל 45מתחת לגיל , נשים יהודיות 45מתחת לגיל , גברים יהודים
Lung cancer incidence, selected countries
Globocan 2012: Estimated cancer incidence, mortality and prevalence worldwide
in 2012
http://globocan.iarc.fr/Default.aspx
-100 -80 -60 -40 -20 0 20 40 60
Hungary
Turkey
Poland
Belgium
Lithuania
Spain
France (metropolitan)
Bulgaria
Russian Federation
Czech Republic
Greece
Estonia
Ukraine
The Netherlands
United States of America
Canada
Denmark
Luxembourg
Germany
Italy
Austria
Ireland
Switzerland
United Kingdom
Norway
Portugal
Finland
Israel
Sweden
Females Males
Lung cancer mortality, selected countries
-80 -60 -40 -20 0 20 40
Hungary
Turkey
Poland
Belgium
Estonia
Bulgaria
Lithuania
Russian Federation
Greece
Spain
France (metropolitan)
Czech Republic
Ukraine
The Netherlands
Denmark
United States of America
Italy
Luxembourg
Canada
Germany
United Kingdom
Ireland
Austria
Israel
Portugal
Norway
Finland
Switzerland
Sweden
Females Males
Globocan 2012: Estimated cancer incidence, mortality and prevalence worldwide
in 2012
http://globocan.iarc.fr/Default.aspx
Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients
from 279 population-based registries in 67 countries (CONCORD-2) . Allemani C, Weir HK, Carreira
H, et al., and the CONCORD Working Group, Lancet 2014
The CONCORD study of net cancer survival
Calculating net (relative) survival
Net survival=percentage of cancer patients surviving to a
given end point, after eliminating other potential causes of
death
Takes into account competing risks of death that are more
likely in elderly patients than in younger patients
Expected background mortality calculated using population
data from the countries represented by the participating
registries
Supplement to: Allemani C, Weir HK, Carreira H, et al, and the CONCORD Working Group. Global surveillance of cancer survival 1995–2009: analysis
of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 2014; published online Nov 26.
http://dx.doi.org/10.1016/S0140-6736(14)62038-9.
Standardized five year net survival for lung cancer in Israeli adults rose from
17.3% (95% CI 16.3-18.3) in patients diagnosed in 1995-1999 to 23.8%
(95% CI 22.8-24.9) in patients diagnosed in 2005-2009
http://www.health.gov.il/UnitsOffice/HD/ICDC/ICR/CancerIncidence/Pages/about.aspx
INCR on the internet
Analysis of cancer trends, overall and by site
Survival analyses
Linkage projects to study cancer incidence in selected
populations (according to diagnosis, treatment history,
occupation, area of residence, demographic factors)
Evaluation of intervention programs
Research using INCR data
Recent publications using INCR data Lavy R, Kapiev A, Poluksht N, Halevy A, Keinan-Boker L. "Incidence trends and mortality rates of gastric cancer in
Israel" (2013). Gastric Cancer 16(2):121-5.
Nakash O, Barchana M, Liphshitz I, Keinan-Boker L, Levav I. "The effect of cancer on suicide in ethnic groups with a differential suicide risk" (2013). European Journal of Public Health 23(1): 114-5.
Keinan-Boker L, Baron-Epel O, Fishler Y, Liphshitz I, Barchana M, Dichtiar R, Goodman M. "Breast Cancer Trends in Israeli Jewish and Arab women, 1996-2007" (2013). European Journal of Cancer Prevention 22(2):112-120.
Nakash O, Liphshitz I, Keinan-Boker L, Levav I. "The effect of cancer on suicide among elderly Holocaust survivors" (2013). Suicide and Life Threatening Behavior 43(3):290-5.
Levine H, Afek A, Shamis A, Derazne E, Tzur D, Astman N, Keinan-Boker L, Mimouni D, Kark JD. "Country of origin, age of migration and risk of cutaneous melanoma: a migrant cohort study of 1,100,000,Israeli men" (2013). International Journal of Cancer 133(2):486-94.
Levi Z, Kark JD, Shamis A, Derazne E, Tsur D, Keinan-Boker L, Liphshitz I, Niv Y, Furman A, Afek A. "Body mass index and socioeconomic status in adolescence, country of origin, and the incidence of gastro-eosophageal adenocarcinoma in a cohort of 1 million men" (2013). Cancer 119(23):4086-93.
Recent publications using INCR data Leiba A, Kark JD, Afek A, Derazne E, Keinan-Boker L, Holtzman, EJ, Shamiss A, Kreiss I. "Hypertension in
Adolescence is not an Independent Risk Factor for Renal Cancer: A cohort study of 919,000 males" (2013).
Journal of the American Society of Hypertension 7(4):283-8.
Kohn R, Levav I, Liphshitz I, Barchana M, Keinan-Boker L. "Cancer incidence and mortality following exposure
to distal and proximal major stressors". (2014). Social Psychiatry and Psychiatric Epidemiology 49;703-9.
Leiba M, Kreiss I, Leiba A, Afek A, Derazne E, Keinan-Boker L, Nagler A, Shamiss A, Kark JD. "Second
generation Jewish immigrants of middle eastern origin have a lower incidence of Multiple Myeloma compared to
Ashkenazi Jews in a cohort of 746,200 Israeli men followed from late adolescence" (2014). Leukemia and
Lymphoma Jan 28. [Epub ahead of print]
Laitman Y, Simeonov M, Keinan-Boker L, Liphshitz I, Friedman E. "Breast cancer risk prediction accuracy in
Jewish Israeli high risk women using the BOADICEA and IBIS risk models". (2014). Genetics Research
95(6):174-7.